Anxiety in children and adolescents with autism spectrum disorders

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Abstract

Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.

Section snippets

Methods

This review was based on a systematic search of published articles available through August of 2008. The Psych-Info and Medline online databases were searched concurrently for entries containing any combination of the following terms: (1) autism, asperger(s), or pervasive developmental disorder and (2) anxiety or anxious. Abstracts of identified articles were then screened for the following inclusion criteria: (a) the target population included school-age children or adolescents (between 6 and

Prevalence

Large-scale epidemiological studies have not been conducted on the prevalence of co-occurring anxiety disorders in ASD. However, the studies reviewed here indicate that between 11% and 84% of children with ASD experience some degree of impairing anxiety (Table 1). In the only studies to examine diagnosed anxiety disorders in ASD, de Bruin, Ferdinand, Meester, de Nijs, and Verheij (2006) found that slightly more than 55% of the sample met criteria for at least one anxiety disorder and Simonoff

Discussion

Although the relationship between ASD and anxiety is not fully understood at this time, it is evident that anxiety is a problem for a substantial number of individuals with ASD. This review was undertaken to: (1) identify areas in which further research is needed, with consideration of some of the methodological limitations seen across the studies reviewed; (2) draw general conclusions about the prevalence, phenomenology, and treatment of anxiety in ASD based on the reviewed literature; and (3)

Conclusions

Despite the lack of firm prevalence data on the co-occurrence of anxiety disorders in youth with ASD, problems with anxiety appear more frequently in youth with ASD than in many other clinical and non-clinical populations. The presentation of anxiety is likely affected by age, level of cognitive functioning, ASD-specific difficulties (e.g., over-arousal), and degree of social impairment. Further research is needed to identify the risk factors and etiological pathways for anxiety in ASD. As the

Acknowledgement

This project was supported by a grant from the National Institute of Mental Health [1K01MH079945-01; PI: S. W. White].

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